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DSH110115E WellStar ATLANTA MEDICAL CENTER (Terminated)
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Main Details
Name
WellStar ATLANTA MEDICAL CENTER
Subdivision Name
Wound Care Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110115E
Medicare Provider Number
110115
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/7/2017
Last Recertification Date
8/29/2022
Termination Date
Termination Reason
10/1/2022
Other
Contacts
Authorizing Official
Wellstar Atlanta Medical Center
Thomas M Morris, Chief Operating Officer
(770) 853-9009
Primary Contact
Wellstar Atlanta Medical Center
Valerie Bandy, Director of Pharmacy
(470) 533-9100
Addresses
Street Address
285 Boulevard NE, L3
Atlanta, GA 30312
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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